Chronic instability of the anterior syndesmosis of the ankle

Beumer, Annachiena

doi:10.1080/17453670710046530

Cited by 18 publications

(25 citation statements)

References 104 publications

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“…Therefore, the ATIFL was not completely ruptured, as suggested by the image in the axial plane. Although an isolated rupture of the ATIFL can be treated non-operatively, it should preferably be treated in plaster, whilst a sprain, i.e., a partial rupture of the anterior syndesmosis, can be treated functionally [ 27 ]. An additional finding of interest was a bone bruise of the distal tibia as indicated by the high signal intensity area on the coronal short tau inversion recovery (STIR) image (Fig.…”

Section: Resultsmentioning

confidence: 99%

The additional value of an oblique image plane for MRI of the anterior and posterior distal tibiofibular syndesmosis

et al. 2010

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ObjectiveThe optimal MRI scan planes of collateral ligaments of the ankle have been described extensively, with the exception of the syndesmotic ligaments. We assessed the optimal scan plane for depicting the distal tibiofibular syndesmosis.Materials and MethodsIn order to determine the optimal oblique caudal-cranial and lateral-medial MRI scan plane, two fresh frozen cadaveric ankles were used. The angle of the scan plane that demonstrated the anterior and posterior distal tibiofibular ligament uninterrupted in their full length was determined. In a prospective study this oblique scan plane was then used in addition to the axial and coronal planes, for MRI scans of both ankles in 21 healthy volunteers. Two observers independently evaluated the anterior tibiofibular ligament (ATIFL) and posterior tibiofibular ligament (PTIFL) regarding the continuity of the individual fascicles, thickness and wavy contour of the ligaments in both the axial and the oblique plane. Kappa was calculated to determine the interobserver agreement. McNemar’s test was used to statistically quantify the significance of the two scan planes.ResultsIn the axial plane the ATIFL was in 31% (13/42) partly and in 69% (29/42) completely discontinuous; in the oblique plane the ATIFL was continuous in 88% (37/42) and partly discontinuous in 12% (5/42). Compared with the axial plane, the oblique plane demonstrated significantly less discontinuity (p < 0.001), but not significantly less thickening (p = 1.00) or less wavy contour (p = 0.06) of the ATIFL. In the axial scan plane the PTIFL was continuous in 76% (32/42), partially discontinuous in 19% (8/42) and completely discontinuous in 5% (2/42); in the oblique plane the PTIFL was continuous in 100% (42/42). Compared with the axial plane, the oblique plane demonstrated significantly less discontinuity (p = 0.002), but not significantly less thickening (p = 1.00) or less wavy contour (p = 0.50) of the PTIFL. The interobserver agreement score and kappa (κ) regarding the continuity for the ATIFL in the axial and oblique planes was 91% (κ = 0.79) and 91% (κ = 0.55) respectively; for the PTIFL it was 86% (κ = 0.65) and 100% (κ = not defined).ConclusionThe ATIFL and PTIFL are routinuely scanned in the orthogonal planes. The advantage of MRI scanning in an oblique image plane of about 45 degrees permits a better evaluation of the ligaments compared with the axial plane, particularly a better interpretation of ligament continuity, thickening and wavy contour. This may lead to a reduction in false-positive results, especially regarding partial or complete ligament ruptures. This can be of considerable aid in therapeutic management.Electronic supplementary materialThe online version of this article (doi:10.1007/s00256-010-0938-9) contains supplementary material, which is available to authorized users

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Section: Resultsmentioning

confidence: 99%

The additional value of an oblique image plane for MRI of the anterior and posterior distal tibiofibular syndesmosis

et al. 2010

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“…Further assessment of parameters indicating syndesmotic instability was performed. These parameters are: unilateral absence of tibiofibular overlap in the AP radiograph [ 30 , 31 ], and a medial clear space that is larger than the superior clear space, furthermore the distance between the medial side of the fibula and the deepest point of the tibial incisure should not exceed 5 mm [ 19 , 30 ]. Patients' details are displayed in Table 1 .…”

Section: Methodsmentioning

confidence: 99%

“…It is an 'open book' injury of the mortise in which the fibula rotates externally allowing a greater range of motion of the talus [ 3 ]. In patients with chronic complaints after an injury, the symptoms and signs as mentioned above in combination with the mechanism of trauma, and a thorough physical examination, which includes tests to assess the integrity of the ligaments of the syndesmosis, should arouse a strong suspicion of chronic instability anterior syndesmosis [ 19 , 20 ]. There are specific syndesmosis stress tests.…”

Section: Introductionmentioning

confidence: 99%

Chronic instability of the anterior tibiofibular syndesmosis of the ankle. Arthroscopic findings and results of anatomical reconstruction

Wagener

Beumer

Swierstra

2011

BMC Musculoskelet Disord

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BackgroundThe arthroscopic findings in patients with chronic anterior syndesmotic instability that need reconstructive surgery have never been described extensively.MethodsIn 12 patients the clinical suspicion of chronic instability of the syndesmosis was confirmed during arthroscopy of the ankle. All findings during the arthroscopy were scored. Anatomical reconstruction of the anterior tibiofibular syndesmosis was performed in all patients. The AOFAS score was assessed to evaluate the result of the reconstruction. At an average of 43 months after the reconstruction all patients were seen for follow-up.ResultsThe syndesmosis being easily accessible for the 3 mm transverse end of probe which could be rotated around its longitudinal axis in all cases during arthroscopy of the ankle joint, confirmed the diagnosis. Cartilage damage was seen in 8 ankles, of which in 7 patients the damage was situated at the medial side of the ankle joint. The intraarticular part of anterior tibiofibular ligament was visibly damaged in 5 patients. Synovitis was seen in all but one ankle joint. After surgical reconstruction the AOFAS score improved from an average of 72 pre-operatively to 92 post-operatively.ConclusionsTo confirm the clinical suspicion, the final diagnosis of chronic instability of the anterior syndesmosis can be made during arthroscopy of the ankle. Cartilage damage to the medial side of the tibiotalar joint is often seen and might be the result of syndesmotic instability. Good results are achieved by anatomic reconstruction of the anterior syndesmosis, and all patients in this study would undergo the surgery again if necessary.

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“…Injury associated with bony or other ligamentous lesions is more frequent 7. Although the Lauge-Hansen classification has many limitations,8 it allows a basic understanding of ankle injuries 9.…”

Section: Introductionmentioning

confidence: 99%

Suture-button devices are at least as effective as screws for fixation of acute syndesmotic injuries: a systematic review

2018

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Chronic instability of the anterior syndesmosis of the ankle

Cited by 18 publications

References 104 publications

The additional value of an oblique image plane for MRI of the anterior and posterior distal tibiofibular syndesmosis

The additional value of an oblique image plane for MRI of the anterior and posterior distal tibiofibular syndesmosis

Chronic instability of the anterior tibiofibular syndesmosis of the ankle. Arthroscopic findings and results of anatomical reconstruction

Suture-button devices are at least as effective as screws for fixation of acute syndesmotic injuries: a systematic review

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